Journal of Immigrant and Minority Health

, Volume 10, Issue 2, pp 167–176 | Cite as

Health Coverage of Low-Income Citizen and Noncitizen Wage Earners: Sources and Disparities

  • Ninez A. PonceEmail author
  • Susan D. Cochran
  • Vickie M. Mays
  • Jenny Chia
  • E. Richard Brown
Original Paper


The health coverage of low-income workers represents an area of continuing disparities in the United States system of health insurance. Using the 2001 California Health Interview Survey, we estimate the effect of low-income wage earners’ citizenship and gender on the odds of obtaining primary employment-based health insurance (EBHI), dependent EBHI, public program coverage, and coverage from any source. We find that noncitizen men and women who comprise 40% of California’s low-income workforce, share the disadvantage of much lower rates of insurance coverage, compared to naturalized and U.S.-born citizens. However, poor coverage rates of noncitizen men, regardless of permanent residency status, result from the cumulative disadvantage in obtaining dependent EBHI and public insurance. If public policies designed to provide a health care safety net fail to address the health care coverage needs of low-wage noncitizens, health disparities will continue to increase in this group that contributes essentially to the U.S. economy.


Health insurance Health disparities Immigrants Latinos Gender Citizenship 



This work was supported by several grants to the coauthors: the National Center for Minority Health and Health Disparities (P60 MD00508; Dr. Mays), the California Wellness Foundation (Dr. Brown), the National Institute of Mental Health (MH 6177; Drs. Cochran and Mays) and the National Institute of Drug Abuse (DA 15539; Drs. Cochran and Mays). Additionally, Dr. Ponce received support from the National Cancer Institute (1 K07 CA100097) in preparing the manuscript. The California Health Interview Survey is a collaborative project of the UCLA Center for Health Policy Research, the California Department of Health Services, and the Public Health Institute, funded by various federal and state agencies and private foundations.


  1. 1.
    Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff (Millwood) 2001;20:247–56.CrossRefGoogle Scholar
  2. 2.
    Pollock H, Kronebusch K. Health insurance and vulnerable populations. In: McLaughlin CG, editor. Health policy and the uninsured. Washington, DC: The Urban Institute Press; 2004.Google Scholar
  3. 3.
    Ponce N, Nordyke RJ, Hirota S. Uninsured working immigrants: a view from a California county. J Immigr Health 2005;7:45–53.PubMedCrossRefGoogle Scholar
  4. 4.
    Thamer M, Richard C, Casebeer AW, Ray NF. Health insurance coverage among foreign-born US residents: the impact of race, ethnicity, and length of residence. Am J Public Health 1997;87:96–102.PubMedGoogle Scholar
  5. 5.
    Holahan J, Pohl MB. States as innovators in low-income health coverage. Washington, DC: The Urban Institute; 2002.Google Scholar
  6. 6.
    Garrett B. Employer-sponsored health insurance coverage: sponsorship, eligibility, and participation patterns in 2001. Kaiser Commission on Medicaid and the Uninsured; 2004.Google Scholar
  7. 7.
    Buchmueller TC, Lo Sasso AT, Lurie I, Senesky S. Immigrants and employer-sponsored health insurance. Working Paper, University of California, Irvine; 2005.Google Scholar
  8. 8.
    Brown ER, Ponce N, Rice T, Lavarreda SA. The state of health insurance in California: findings from the 2001 California Health Interview Survey; 2003.Google Scholar
  9. 9.
    Blumberg LJ, Davidoff AJ. Exploring state variation in uninsurance rates among low-income workers. The Urban Institute; 2003.Google Scholar
  10. 10.
    Goldman DP, Smith JP, Sood N. Legal status and health insurance among immigrants. Health Aff (Millwood) 2005;24:1640–53.CrossRefGoogle Scholar
  11. 11.
    Paral R. Essential workers: immigrants are a needed supplement to the native-born labor force. American Immigration Law Foundation; 2005.Google Scholar
  12. 12.
    Borjas GJ. Welfare reform, labor supply, and health insurance in the immigrant population. J Health Econ 2003;22:933–58.PubMedCrossRefGoogle Scholar
  13. 13.
    Zimmermann W, Tumlin KC. Patchwork policies: state assistance for immigrants under welfare reform. Washington, DC; 1999.Google Scholar
  14. 14.
    Hadley J. Sicker and poorer: the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income. Med Care Res Rev 2003;60:3S–75S.PubMedCrossRefGoogle Scholar
  15. 15.
    Rice T, Lavarreda SA, Ponce NA, Brown ER. The impact of private and public health insurance on medication use for adults with chronic diseases. Med Care Res Rev 2005;62:231–49.PubMedCrossRefGoogle Scholar
  16. 16.
    Coverage matters: insurance and health care. Washington, DC: National Academy Press; 2001.Google Scholar
  17. 17.
    Carrasquillo O, Pati S. The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States. Prev Med 2004;39:943–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Lucas JW, Barr-Anderson DJ, Kington RS. Health status, health insurance, and health care utilization patterns of immigrant Black men. Am J Public Health 2003;93:1740–7.PubMedGoogle Scholar
  19. 19.
    Buchmueller TC. Marital status, spousal coverage, and the gender gap in employer-sponsored health insurance. Inquiry 1996;33:308–16.PubMedGoogle Scholar
  20. 20.
    California Health Interview Survey. CHIS 2001 methodology series: report 1—sample design. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  21. 21.
    Ponce NA, Lavarreda SA, Yen W, Brown ER, DiSogra C, Satter D. Translation methodology in the California Health Interview Survey: challenges in language translation for a major survey. Public Health Rep 2004;119:1–18.CrossRefGoogle Scholar
  22. 22.
    California Health Interview Survey. CHIS 2001 methodology series: report 4—response rates. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  23. 23.
    2001 Poverty Guidelines. Federal register 2001. 2001;66:10695–7.Google Scholar
  24. 24.
    Thamer M, Rinehart C. Public and private health insurance of US foreign-born residents: implications of the 1996 welfare reform law. Ethn Health 1998;3:19–29.PubMedCrossRefGoogle Scholar
  25. 25.
    Carrasquillo O, Carrasquillo AI, Shea S. Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am J Public Health 2000;90:917–23.PubMedGoogle Scholar
  26. 26.
    Fronstin P, Goldberg LG, Robins PK. Differences in private health insurance coverage for working male Hispanics. Inquiry 1997;34:171–80.PubMedGoogle Scholar
  27. 27.
    Mays VM, Ponce NA, Washington DL, Cochran SD. Classification of race and ethnicity: implications for public health. Annu Rev Public Health 2003;24:83–110.PubMedGoogle Scholar
  28. 28.
    California Health Interview Survey. CHIS 2001 methodology series: report 5—weighting and variance estimation. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  29. 29.
    Bovbjerg RR, Hadley J, Pohl MB, Rockmore M. Medicaid coverage for the working uninsured: the role of state policy. Health Aff 2002;21:231–43.CrossRefGoogle Scholar
  30. 30.
    Mohanty SA, Woolhandler S, Himmelstein DU, Pati S, Carrasquillo O, Bor DH. Health care expenditures of immigrants in the United States: a nationally representative analysis. Am J Public Health 2005;95:1431–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Weisman J: House votes to toughen laws on immigration. One setback for bush: no guest-worker plan. Washington Post December 17; 2005.Google Scholar
  32. 32.
    President Bush Proposes New Temporary Worker Program. In: Washington, DC: White House; 2004.Google Scholar
  33. 33.
    California Health Interview Survey. CHIS 2001 technical report—revised CHIS 2001 weights. Los Angeles, CA: UCLA Center for Health Policy Research; 2005.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ninez A. Ponce
    • 1
    • 6
    Email author
  • Susan D. Cochran
    • 2
    • 3
    • 5
  • Vickie M. Mays
    • 1
    • 4
    • 5
  • Jenny Chia
    • 6
  • E. Richard Brown
    • 1
    • 6
  1. 1.Department of Health ServicesUCLA School of Public HealthLos AngelesUSA
  2. 2.Department of EpidemiologyUCLA School of Public HealthLos AngelesUSA
  3. 3.UCLA Department of StatisticsLos AngelesUSA
  4. 4.Department of PsychologyUCLALos AngelesUSA
  5. 5.UCLA Center on Research, Education, Training and Strategic Communication on Minority Health DisparitiesLos AngelesUSA
  6. 6.UCLA Center for Health Policy ResearchLos AngelesUSA

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